I-SIS Special Series, Inside Human Genetic and Genomics, Part 2
Continuing crisis in the National Health Service in Britain has been hitting the headlines almost daily. The nation desperately needs to invest in research that can improve the health of its citizens. But research funds are being swallowed up by ‘health genomics’, research that could do little else for people’s health than to enable pharmaceutical companies to further drain the NHS in expensive patented diagnostics, drugs and therapies. Sam Burcher and Dr. Mae-Wan Ho report.
The crisis in Britain’s National Health Service (NHS) has been deepening for the past decade (Box 1). The NHS was given 9% more cash in 2001. The annual budget for 1999-2004 is to rise from £49.3bn to £78.7bn. But sixty percent of the increase has already been spent with little sign of improvement [1]. The NHS waiting list rose from an average of 1.045 million during the last Tory administration to 1.114 million under Labour, a 6% increase. The waiting list to see a consultant is up 68% from 238 000 to 401 000. The government is exporting patients abroad for treatment, after forbidding the practice for years.
Disturbingly, old people are half as likely to receive treatment as the young, they are more likely to be left to die. Treatment for other groups are at the mercy of ‘postal code’ lottery, ie depending on where they happen to live. Hospital acquired infections are at an all time high of 100 000 per year, and 5000 die. Casualty waits in the emergency wards exceed 24 hours. There is mass exodus of nurses from the NHS, already severely understaffed.
The Chancellor was forced to announce another billion for the NHS and hinted at tax increases to come. That brings a total of 6 billion extra just for 2002, an increase of 7%. But this will be another drop in an ever-expanding ocean. While the average European country spends 9% of their Gross Domestic Product on health, Britain will reach 7.6% only by 2004 [2].
Chronic under-funding is compounded by mounting costs of medical equipment and drugs, rising faster than inflation and yielding record profits for the pharmaceutical industry. The pharmaceutical’s average 18.9% profit-to-revenue ratio was, by far, the highest of any industry in the United States (Box 2). Britain’s pharmaceutical industry is second only to the US.
It is not only the lack of funds, but "chaos from top down", mismanagement and lack of forward planning.
The lack of forward planning in national health is nowhere more evident than in the persistent under-investment in research that promotes health instead of reinforcing illness. Mainstream research has focussed disproportionately on diagnosing diseases and developing expensive treatments and drugs that allows the profit-hungry pharmaceutical industry to drain the nation’s health and life blood like a vampire.
Drugs are being regularly overused and abused in industrialised countries with disastrous effects. Successive studies have documented a rising epidemic of iatrogenic diseases, ie, diseases caused by medical treatments, interventions and drugs. By 2000, doctors became the third leading cause of death in the US killing 250 000 every year, among which are 106 000 from non-error negative effects of drugs [3]. The latest statistics show that older people in care are given four times as many prescription drugs in Britain, and deaths caused by prescription drugs have gone up five fold in the last ten years (Box 3).
The current massive investment into ‘health genomics’ and related research is explicitly aimed at identifying the maximum possible number of expensive patented gene drugs and treatments. It has contributed almost nothing to the health of the nation, and is unlikely to [4]. On the contrary, it is taking resources away from other approaches that can deliver genuine health to the poor as well as the rich.
A major pressure on the NHS is an increasingly aged and sickly population. Two thirds of the NHS resources currently go to caring for the aged, and the pressure will grow as people live longer. Yet, there is a distinct lack of research funding into aging [5]. Similarly, despite the growing popularity of complementary or alternative medicine (CAM), there is almost no support for research in that area (Box 4).
More important than documenting the clinical efficacy of CAM is to support research into holistic models of health, and the development of non-invasive diagnostics and effective treatments based on minimum intervention. The rising epidemic of iatrogenic diseases is a sign that the reductionist model that informs conventional western medicine is failing under its own weight of maximising intervention, side-effects and costs [6]. At the same time, there is an urgent need to recover and revitalise indigenous herbal medicines and health systems before they are driven to extinction by the dominant, market-driven model.
Indeed, our health policy makers may have something to learn from countries like Cuba that has managed to deliver health at less than one-hundredth of what it costs us in Britain (Box 5). Equality in access to primary care and prevention are some of the key features, not expensive drugs and treatments.
Box 1
Old patients left to die
Analysis of12,000 case-studies in twenty Scottish hospitals revealed that younger patients are twice as likely to receive the best available treatments, while some older patients are left to die.1 A study compared 30 year-old with 70 year-old patients admitted to Accident & Emergency, and found that the 70 year-old is 26% less likely to be admitted to intensive care and 35% less likely to be sent to the resuscitation room. The 70 year-old patient with the same head injury as a 30-year-old is 50% less likely to be sent to the neurological surgery ward.2
Hospital acquired Infections kill up to 5,000 patients in England per year
These infections are caused by breaking simple hygiene rules such as hand washing between the treatment of patients.3 Susceptible patients with impaired immune systems fall prey to a rapid spread of pathogens, and with few isolated single bed wards, infections multiply. Methicillin Resistant Staphylococcus aureas is particularly virulent. Estimates suggest that at least 100,000 cases of hospital acquired infections are reported each year.
Casualty wait exceeds 24 hours
A spot check of hospital casualty departments by a community watchdog found at least 20 patients exposed to "unacceptable" waits of 24 hours or more.4 A 93-year-old woman with hypothermia was delayed in Accident & Emergency for 30 hours before being admitted to the ward. And a 41-year-old female spent 54 hours in the casualty department awaiting investigations.
Waiting lists increase
Waiting lists are described as "inhuman, insane, uncivilised and cruel" by a leading orthopaedic surgeon whose elderly patient waited six years for a knee operation. A leaked National Audit report found hospitals manipulating patient data to give the appearance of shorter waiting lists.5 And 1 in 5 patients are incorrectly suspended from waiting list to meet waiting list targets rather than medical needs. This has forced one man to sell his share of the family home to finance a trip to Cape Town for a heart operation.
NHS exports British patients
Thousands of waiting list patients are to be sent abroad for operations. The health secretary Alan Milburn has scrapped any regulations under the 1977 Health Act that denies treatment to UK citizens abroad.6 A scheme (E112) already exists where, under exceptional circumstances, UK passport holders can obtain medical care abroad, and it has been operative since 1973. The new scheme, fully fledged by 2002, will allow groups of patients to go abroad for operations rather than having them in the UK.
Mass exodus of nurses
The shortage of nurses has led the government to take drastic action. They are setting up their own NHS staff agency in a bid to compete with private agencies.7 Annual national costs of agency and temporary nursing run at £810 million. In the capital, 22 hospitals have got together to cap commissions charged by agencies by agreeing to use only those from an approved list. However these rates lure NHS nurses into agency work. Remuneration for the same service in the same hospital is £22 per hour for the agency nurse and £12 for the NHS nurse.
Chaos from top down
An eminent consultant who worked within the NHS for 31 years has launched a searing attack on "dishonest" politicians for making doctors the fall guys for lack of planning and resources. Dr Michael Gross, pioneer of a migraine treatment and retired chairman of Neurosciences at Royal Surrey County Hospital said the NHS was "in chaos from top to bottom".8 Under-funding has "forced doctors and nurses to make choices as to who will receive how much care as opposed to everyone receiving what they need." He left the NHS when his hospital closed its neurological department abandoning a vast list of patients to no local care. He now works privately as consultant and for a neurological charity.
Box 2
Pharmaceutical profits top the league
The top seven pharmaceutical companies took in more profit by a wide margin than the top seven auto companies, the top seven oil companies, the top seven airline companies, and the top seven media companies.
One drug company, Merck, pocketed more in pure profit than all of the airline companies in the world’s 500 largest corporations, and bested the entertainment and construction industries as well. Most significantly, the pharmaceutical’s average 18.9% profit-to-revenue ratio was, by far, the highest margin of any industry in the nation.
The 1999 revenues in millions and profits as percentage of revenue for some of the big drug companies are as follows Merck $32 714 (18%), Novartis $32 465 (21%) BMS $20 222 (20%), Glaxo Wellcome $14 133 (19%), Abbott $13 178 (27%), Warner-Lambert $12 929 (23%) SmithCline $12 622 (11%), Eli Lilly $10 003 (33%).
Sources: "New figures prove pharmaceutical industry continues to fleece Americans" by Congressman Bernard Sanders, Washington DC http://www.bernie.house.gov/prescriptions/profits/asp; Pharmaceutical company profits and salaries by Richard Laing, Dept. of International Health, School of Public Health, Boston University, presented at Durban South Africa AIDS Conference 11 July 2000 www.actupny.org
Box 3
Drugging us to death
A report released by Liberal Democrat Member of Parliament in December 2001 reveals how older people in care are given four times as many prescription items as a person living in their home. Anti-psychotic drugs in nursing and residential homes are vital against schizophrenia and other forms of severe mental illness in about one in 10 residents. But research both in Britain and overseas suggests another 2 out of 10 are given the drugs for no medical reasons. Thus, as many as 35 000 in nursing homes and 53 500 in residential homes are being inappropriately treated. Worse, the side-effects - constipation, dizziness, drowsiness, fainting – may help lead to misdiagnosis of real health problems, and even to death.
In the same month, the National Audit Office documented a five-fold increase in deaths due to prescription drugs over the past ten years, from 250 to 1200.
Sources: "Going quietly" by James Meikle, Guardian G2, 5 December 2001."Today programme", BBC Radio 4, 17 December, 2001.
Box 4
Investment urgently needed for holistic health and complementary medicine
A report by The House of Lords Select Committee on Science and Technology last year highlighted an urgent need for more research into complementary and alternative medicine (CAM). Consumers spend £1.6 billion a year on CAM. The medical establishment calls for more proof that alternative therapies work, but funding in the UK for research into complementary medicine, notably in comparison with such funding in the US, is pitiful.
CAM has been growing in popularity throughout the 1990s. By 1997, U.S. consumers spent more than $27 billion in out-of-pocket expenses on CAM and made more than 629 million visits to alternative providers, almost double the 386 million visits to primary care physicians during the same period.
The first major response to the need for more research by the federal government in US occurred in 1992, when Congress set up the Office of Alternative Medicine (OAM) as a division of the National Institutes of Health. It was designed with three goals in mind: establishing an emphasis of rigorous scientific testing of CAM treatments; developing an infrastructure to coordinate and conduct research; and establishing a clearinghouse to deliver information to the public.
Since the OAM’s inception, funding into CAM research has risen significantly, from just $2 million in the first year, to approximately $50 million in 1999 and $68 million in 2000. This jumped to $89.2 million - an increase of over $20 million in 2001.
In Britain, less than 8p out of every £100 of NHS funds for medical research were spent on complementary medicine. In 1998-99 the Medical Research Council spent no money on it at all, and in 1999 only 0.05% of the total research budget of UK medical charities went to this area. The Arthritis Research Campaign is one of few such organisations to take account of the huge rise in the numbers of people using non-conventional therapies. It has announced funding into complementary and alternative therapies, beginning with a two-year clinical trial into the effects of acupuncture on patients with osteoarthritis of the knee.
Sources: "Complementary and alternative medicine needs - and deserves - more research" by The Prince of Wales, The Times, December 30, 2000.
House of Lords Science and Technology – sixth Report, Session 1999-2000, Publications on the Internet, Science and Technology Publications
"Congress increases funding for CAM research by $20 million. Acupuncture Today (Editorial@AcupunctureToday.com)
Box 5
Cuba delivers superior national health at less than one-hundredth the cost
Officials from the Department of Health and 100 GPs visited Cuba not so long ago to see how that country delivers health care at a fraction of our cost. Despite political struggles and trade embargoes, excellent healthcare is provided at £7.00 per head. UK healthcare costs £750 per head. Cuban family doctors are plentiful and have a higher training standard than our GPs with a ratio 1 doctor to 500-700 people. No one lives more than 20 minutes from a "consultorio", a three storey building houses a medical practice on the ground floor, the doctor’s flat on the first floor and the nurses flat on the second floor. Cuba has 21 medical schools and 37,000 practice nurses, 30,000 GP’s and a population a fifth the size of UK. In the UK, the ratio is one doctor to 1800-2000 patients, and there are10,300 nurses, 30,000 GPs and 12 medical schools.
Source: Boseley S. "Cubans tell NHS the secret of £7 a head healthcare." The Guardian Monday October 2nd 2000. Guardian Newspapers Limited 2001.
Article first published 10/02/02
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